A professional educational model to provide insight into what is going on with all aspects of secure wireless medical connectivity both across the integrated delivery network, the enterprise business model, and at the device point of care of which includes the connected medical device. The goal of this content is to provide technology information and direction to help transform healthcare in 2016 and beyond through all aspects of wireless connectivity and cybersecurity. The desired result is to improve patient care and the total clinical mobility experience across the healthcare enterprise in a secure fashion.

May 2012

May 31, 2012

As I have mentioned in my first blog about the recent announcement of the approved spectrum of the BAN by the FCC….this is a follow on. This posting will draw upon the benefits of using industry standards (solutions) and how proprietary solutions such as the recent BAN simply just are not needed. WMTS will be used as a case study.
We are aware of the rising costs of healthcare and somehow we need to try to contain costs by improving process and doing things differently.

If you carefully follow technology and the adoption of it…pretty much in 100% certainty it comes first from the consumer, then it goes to the enterprise. Witness the WiFi revolution. When the extension of 802.11 came out (i.e. 802.11b), WLAN adapters and access points were somewhat costly. However based upon the adoption of www.ieee.org, interoperability by the WiFi Alliance, and the silicon vendors…costs were driven down in a rapid fashion. Now instead of WLAN adapters being hundreds of dollars they are now embedded chips that are less than a few bucks or less.

Existing modeling tools such as from www.airmagnet.com, www.motorola.com, and www.ixiacom.com exist for the right deployment of enterprise WLANS. Companies like www.motorola.com and www.enterasys.com continue to push the envelope of enhancing value to the enterprise by driving down costs and improving the WLAN model.

Bluetooth has followed a similar path with vendor interoperability . www.bluetooth.com Today virtually every I-Phone and Android type of device today has WiFi and either Bluetooth and now Low Power Bluetooth. Interoperability and co-existence with WiFi has been proven in hundreds of millions of devices on a global basis.
See…also this is ANT. www.thisisant.com I have also attached the Q1 2012 newsletter from Nordic Semiconductor. (The author has worked with Nordic to help a start-up evaluate the best pathway for using ultra low power wireless technologies.) This newsletter does a very good job in outlining and describing all the standards based enterprise based low power PAN solutions.

Download Cc2571
The recent announcement of the new spectrum simply is not needed. (My opinion). It seems that this is again an attempt by some major medical device manufacture’s to carve out some uniqueness…when commoditization of patient monitoring has occurred. Some should question…why is this needed? Protected spectrum?….just look what happened to WMTS. This also will drive up costs…big time...then the big companies can dictate the price of their products.

Some things to point out regarding WMTS (proprietary WMTS…versus enterprise 802.11)

WMTS limitations

1. No site survey tools exist
2. No real time SNMP management or other method, leads to running a network in the dark compared with the high-level tools for BT and WiFi solutions. No management = high risk.
3. How many FDA 510k WMTS products have been approved in the past five years as compared to approved WLAN enabled medical devices?
4. Congress has just authorized/required the FCC to relocate incumbent (read medical and astronomy) users of the 608-614MHz (channel 37) band to different bands. That is the U.S. Congress has undermined the very foundation of WMTS. Here is the specific clause: “ a channel 37 incumbent user, in order to relocate to other suitable spectrum, provided that all such users can be relocated and that the total relocation costs of such users do not exceed $300,000,000. For the purpose of this section, the spectrum made available through relocation of channel 37 incumbent users shall be deemed as spectrum reclaimed through a reverse auction under section 6403 (a)”.

5. At 604-614MHzm using 25khz channel spacing limited to only 240 channels and this had to be throttled back due to interferers. As telemetry is going house wide...this seriously limits the usefulness of WMTS for widespread “whole hospital deployments. (Baker and Hoglund, pages 1 and 2).
6. Custom radios by each manufacturer. Custom radios do not benefit from the high volume of the consumer market.
7. High costs of custom antenna systems versus WLAN.WMTS has driven up costs for healthcare in an exponential fashion…when WLAN is proven.

No doubt the same pathway will be followed with BAN….when standards based low power and low cost enterprise based wireless solutions are available today. One should challenge proprietary solutions when the goal is to lower costs of healthcare!

May 27, 2012

I have been contacted by a least one major medical device company about my input as well as another consultant that have asked me to blog. The FCC has designated 40 megahertz in the 2.3 GHz frequency band for short-range, wideband transmission within medical facilities and homes. Basically the best of industry and networking practices can and have demonstrated effective and safe use of the current available unlicensed spectrum. Over the past 30 years I have been in and around the the medical telemetry space...before WMTS and past...oh yes all aspects of "wireless". Please note that attached article that Dr. Baker and myself authored regarding "wireless in healthcare". (Please see page one and two...WMTS). RF is RF and even though there is dedicated spectrum..unintentional emitters can cause interference. Witness the intense practice by the cellular carriers to monitor their "licensed space" on a vigilant basis. Over the next several days I will author several blogs regarding how the best of practices, the use of standards based wireless spectrum, can lower not only costs...but decrease risk. This move (40 Mhz in 2.3GHz) seems to parallel the intensive meetings via the Baylor incident, the re-allocation of spectrum from VHF and UHF, and request from the FCC for "specific spectrum for WMTS." This caused pretty much the entire medical telemetry marketplace to move out of the UHF and VHF space to WMTS, which accounted to "millions of $$ of spending by hospitals". So the question is why not use commercially available ANT, LPBT, GSM, LTE...etc? Is this an attempt to show a value difference in the increasingly commoditized patient monitoring marketplace? This will be explored as mentioned in upcoming blogs next week. These blogs will be centered on the perhaps reasons why medical device companies (not all) are perhaps doing this and some of the technical questions that I certainly would bring up. I invite all comments on this.

May 24, 2012

Been working with a very unique environment for the past year where the implemented WLAN CCI is so high without any clients it had to have a re-design. (actually fork lift out...that is a whole other story). From a WLAN implementation perspective it not just about signal strength as some think.

For instance the low cost of 802.11 access points makes it tempting to deploy them with very high density. An example, some WLAN networks are being deployed with an access point in every room. This type of deployment has the benefit of increasing the capacity of the network by allowing "spatial reuse" of the spectrum. It somewhat makes sense that by having more APs in the area of deployment, it's more likely that a client will be able to operate successfully even when interference is present.

However, when you deploy a dense network of access points, it's necessary to reduce the transmit signal power of each of the access points. If you don't reduce the power, the access points generate interference to each other, a phenomenon known as co-channel interference. While a wireless voice over IP network might have sufficient signal strength, having a high CCI will drastically degrade the quality of the user experience as the WLAN network is loaded. It is the same as trying to have a quiet conversation with someone next to you at a rock concert. See below basic requirements for wireless voice over IP.

A typical WLAN design for voice over IP must ensure a minimum of -67dBm signal strength on the edge of coverage cell with a SNR of +25dB in all areas where a wireless voice over IP phone is used. There should be -19dBm separation between similar non-overlapping channels. (Example: a client on channel 2 at -67dBm or better should not hear another channel 1 with a reading of -84dBm.) Idle channel utilization must below 10% and % metrics should be defined for loading. The packet error rate (PER) should be no higher than 1% (or a success rate of 99%).

First we had the era of the thick AP (802.11b...1999), then the "thin" AP and controller (early 90's), now we actually are reverting back to the distributed systems model...intelligence at the edge. If we can use the silicon and bring in intelligence in the AP...the controller does not become what I perceive as the "bottleneck"..and then do you really need redundant controllers? Motorola as the superior RF company provides more power per AP and better receive sensitivity versus the competition. (again...what I see from the specifications and analysis).
I was actually around then Symbol/now Motorola to witness this transition.

This Adaptive Architecture providesNo controller bottleneck
Improved application performance
Massive scalability
Collaborative intelligence in APand controller
(Think of the controller as being in the cloud...sort of!)

This all results in a more reliable WLAN design, less cost of ownership, and less TCO. Add in all the forensics of AirDefense..and you bulletproofed your WLAN. Know that Cisco and Aruba battle head to head all the time...but Motorola and others (well at least another that I have blogged about) are have innovation that is changing the landscape of the WLAN.

For at the end of the day...it how to take the commoditized WLAN technology...make it better and better to deliver real business value. Not just about moving widgets.

May 23, 2012

I would have liked to attend this conference, but I just returned from another conference in Las Vegas last week. Definitely what I find the trend is the move to "small cells"...femto and pico cells (the terms) are not really used that much more. The key aspect is about capacity..and LTE is driving this. Like the caregiver here in the hospital...they do not care about the technology...then just want to know...can you hear me now...do I have five bars! Also the days of coaxial cable...well think all optical...stayed tuned in 2012 and 2013. a Glad to see SOLID so "solidly" represented.

One of the most interesting aspects of this whole BYOD area is that the level of response and IT support will spike. In the area of the connected wired or wireless medical device on the network...there will be a need and requirement that these devices continued to provide the same "quality of service" that was previously validated and verified through a FDA 510k approval. You could say that improvements to the "network design" actually may lower risk. Lowering risk is good when more and more medical devices are part of the network. It seems that one company Enterasys while flying under the radar is now flying at the speed of sound. Their High performance ASIC - CoreFlow2 allows control at the "silicon level", while their M2M monitoring provides proactive management. What this all means is IT staff can be used more efficiently. In some instances I have heard that wireless voice over IP help desks calls have been reduced 90%. So...it turns out that a nice OPEX and TCO business model can be tied to this.

May 22, 2012

BYOD is the buzz...not BYOB. Every networking company is chattering about this and every Healthcare CIO is..."should be".."really" concerned. So what does this actually mean?

The Trends
- 81% of employed adults use at least one personally owned device for business use.
- Apple shipped more iPADS in 2 years than MACS in over 20 years.
- 59% of employees use mobile devices to run line of business applications
- 90% have disabled auto-lock for tablets, 75% for smart phones.

IT BYOD Challenges
- 2/3 say preventing unauthorized network access is a somewhat to an extremely important task.
- < 10% of organizations are "fully aware" of the devices access their network.
- 74% of companies allow BYOD usages in some fashion.
- $429,000 is the typical large company loss due to mobile computing mishaps in 2011.
- 1/2 of companies have experienced a data breach due to insecure devices.
- 71% of companies are discussing developing custom mobile applications.

Any BYOD Policy has to be be:
1. Easy to set-up.
2. Does not burden IT resources.
3. Should support a wide range of devices.

I have known Shahid Shah for several years and I consider him one of the most innovative and visionary executives in healthcare today. His insight definitely is not only cutting edge, but real and applicable to the healthcare business world. Suggest that those on the East Coast try to attend his presentation on June 02, 2012 in Baltimore

Technology companies must continually re-invent themselves and provide "value" to the customer...or they risk becoming having their technology becoming somewhat a commodity. For example can the technology in this case "networking, data center, virtualization, wireless, and mobility", actually help IT manage the BYOD? When you discuss BYOD, how can I free up my existing IT resources, drive down costs, and create less risk? As you look at the "Bring your own Device" era and how your network can support this...look beyond the "plumbing" and look at the business value. (Carefully evaluate the CAPEX, OPEX, and TCO)

May 09, 2012

Integra Systems, Inc worked with www.tuv.com and www.wi-fi.org regarding the initial drafts of the test protocols and plans for validation and verification for Sotera Wireless.(EMC/EMI., etc.) We are very happy to see not only the initial predicate FDA 510K approval, but also the enterprise WLAN certification by the WiFi Alliance. These two events are major for this company entering into the commercial patient monitoring space and we are proud to be of the initial domain.